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At the heart of best practices in health care are well-informed decisions based on best-available evidence.

The Clinical Resource Library is a powerful support tool designed to provide busy healthcare professionals with current evidence, education, and tools so that they can make informed decisions and implement best practices on behalf of their patients and facilities.

Take a look around and you'll find a repository of the best publications, relevant education, and helpful toolkits and resources. The Hill-Rom Clinical Resource Library is a searchable database including key references and resources related to Hill-Rom's products and clinical programs.

In this April 2010 Critical Care Nurse issue, several prominent authors discuss the clinical and financial benefits of early mobilization in critically ill patients, as well as how to implement a successful early mobility program in a hospital. Featured articles include:

This article discusses the findings of a survey concerning early mobilization practices and infrastructure in ICUs within the United States. The authors found that only 30% of US ICUs have a written early mobilization protocol. The authors also found that common barriers to mobilization include safety concerns, staffing levels, and competing priorities. They conclude that written early mobility protocols are uncommon, infrastructure is limited, and regional differences exist.

Significant evidence has shown that early mobility programs improve clinical outcomes for patients in critical care conditions. However, the lack of evidence associated with the financial benefit of early mobility programs has served as a barrier to program implementation. This study evaluates the financial benefits associated with the clinical outcomes of early mobility programs in the ICU environment. The study concludes that early mobility programs can generate annual savings up to $1,250,000 for a capitated delivery system, $925,000 for a Hospital, or $325,000 for a private payer.

Pressure ulcers are a relatively common occurrence across all care settings, resulting in significant health burdens. However, risk-assement scales and preventive interventions can decrease the incidence or severity of pressure ulcers.

Early mobility in a neurocritical ICU has shown positive clinical outcomes. This study examines the sustainability and financial outcomes associated with an early mobility program. The authors from UF Health-Shands Hospital, were able to maintain improvements in ICU and hospital length of stay (LOS), which yielded a 13% reduction in cost of patient care. The authors have estimated a combined savings of $12.4 million dollars over a two year time period. They conclude that early mobility programs are able to be implemented and sustained with positive clinical and financial outcomes.

This abstract, presented at ESCIM 2014 in Barcelona, Spain summarizes the findings of an international survey concerning early mobilization practices and infrastructure. The authors found that ICU's infrequently have a written early mobilization protocol (20-30% across four researched countries). The authors also found that common barriers to mobilization include safety concerns, staffing levels and competing priorities. They conclue that written early mobility protocols are uncommon, infrastructure is limited and regional differences exist.

Head of bed (HOB) elevation has been shown to reduce incidence of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. AACN and ATS recommend HOB elevation of at least 30°. The authors of this study measured the relationship between HOB elevation and actual patient position to determine the impact of patient migration. Using motion capture methods on ten healthy participants in a lab setting, the authors were able to quantitatively determine this relationship with a linear regression. The authors conclude that patient migration results in lower HOB elevations. They further state that clinicians should consider protocols and equipment that minimize patient migration in order to help maintain guidelines recommended HOB elevations designed to protect patients from VAP.

Due to rising costs in specialty bed rentals and increased concern over hospital acquired pressure ulcers, Provena St. Joseph Medical Center's 350-bed hospital opted to purchase new pressure redistribution surfaces for all Med-Surg beds. Replacement of the standard foam mattress to the nonpowed, dynamic AccuMax Quantum™ Surface resulted in a 61.5% decrease in facilty-acquired pressure ulcers over a 8-month time period.

This prospective study compared clinical outcomes in ICU patients who either received standard care or an intervention comprised of 20 minutes of exercise once daily for 2-7 days. Patients in the intervention group had a significantly decreased length of stay in the ICU.

This oral abstract presented at the Critical Care Congress in Jan 2013 reviews UNMC's implementation of the ABCDE bundle. It shows that is is both safe and efficacious. Through use of the ABCDE bundle, UNMC saw a reduction of 3 days per patient on a ventilator, a 9 pt reduction in cases of delirium, and an 11pt reduction in mortality.

This article describes a study investigating the effectiveness of increased mobility among neurointensive care unit patients. In this study, a mobility bundle toolkit was utilized, including the Progressive Upright Mobility Protocol (PUMP) algorithm, additional mobility aides were purchased, and interdisciplinary education was initiated. This resulted in increased mobility in neurointensive care unit patients by 300%, reduced LOS in the neurointensive care unit by 13%, significantly decreased hospital LOS (12 days to 8.6 days), decreased hospital-acquired infections by 60%, and significantly decreased ventilator-associated pneumonia from a rate of 2.14 per 1000 days to 0. Increased mobility did not lead to increases in adverse events.

This article reviews the risks associated with immobility (VAP, vent stay, pressure ulcers, reduced QOL after discharge, functional limitations), defines the process of early mobility, and describes barriers to prioritizing positioning and mobility of patients in the ICU. The safety of mobility protocols is reviewed by discussing a study of 103 ICU patients undergoing mobilization, in which <1% experienced an AE due to early mobilization and 69% could ambulate >100 ft. at ICU discharge.

This systematic review articles summarize all papers published from 1999 through 2013 on the topic of physiotherapy in the ICU. It found 85 new articles on the subject, with 26 specifically on the use of early mobility. The findings are clear that early mobility is safe and efficacous, and has human benefits that can reduce ICU and Hospital LOS.

This article describes an initiative to implement an evidence-based early mobility continuum into current ICU culture in 8 hospitals in the United States. This multicenter initiative included process design, culture work, and education. One hundred thirty patients were evaluated, and the results showed substantial utilization of physical therapy within 24 hours of admission and a reduction in ventilator days (3.0 days pre vs. 2.1 days post; p=0.06).

This Institute for Healthcare Improvement white paper provides a great overview of what a healthcare bundle is and the historic context for why they were developed. It then discusses why bundles produce better outcomes for patients.

This article describes strategies for the implementation of a bundle of evidence-based strategies for reducing mortality due to ICU-acquired delirium and weakness: awakening and breathing coordination, delirium monitoring, and exercise/early mobility. Inadequate technology is cited as a barrier to implementation of early mobility therapy.

This randomized trial evaluated the impact of physical and occupational therapy on function outcomes in mechanically vented patients in the ICU. Of 104 patients, 59% returned to independent functional status at discharge in the intervention arm compared with 35% in the control arm. Patients in the intervention arm also had shorter duration of delirium (P=0.02) and more ventilator-free days (P=0.05) compared to the control arm. Discontinuation due to patient instability occurred in 4% of all therapy sessions.

This prospective cohort study evaluated the impact of implementing a mobility protocol on the proportion of ICU patients receiving physical therapy vs. usual care. Eighty percent of protocol patients received greater than 1 physical therapy session compared to usual care (47%). Protocol patients were out of bed 6 days earlier than SICU patients. ICU stay was improved by 1.4 days (P=0.025), and hospital length of stay was improved by 3.3 days (P=0.006) in protocol patients.

This grand rounds presentation and assocaited articles summarizes the challenges patients and hospitals face with immobility, provides the historical background on the matter, and reviews the evidence supporting an early mobility protocol. It then discusses Johns Hopkins experience implementing such a protocol.

This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare reciepients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting.

This observational study evaluated the prevalence of pressure ulcers in acute care facilities. In 2008 and 2009, overall prevalence was 13.5% and 12.3%, respectively. Facility-acquired prevalence was 6% and 5%, respectively. Overall prevalence was highest in long-term acute care, while facility-acquired prevalence was highest in ICUs. Overall and facility-acquired prevalence were lower in 2008-2009 compared to 2006-2007. However, in 2009 approximately 10% of all ulcers were device related.

This study of data from the 2009 IPUP survey focused on pressure ulcer prevalence by BMI and weight distribution revealed the following: the percentage of extremely obese patients increased from 18.3% to 20.6% in 2008-2009, 36% of survey patients have a BMI >30, and pressure ulcer prevalence is higher in patients weighing >300 lbs.

This case study of 3 patients in the home care and extended care settings monitor the healing of existing pressure ulcers and the development of new pressure ulcers in patients on the P400 therapy surface. Positive results for healing were seen in all 3 patients

This article reports data from the international Pressure Ulcer Prevalence survey 2006-2009 in patients with suspected deep tissue injury (sDTI). Overall and facility-acquired pressure ulcer prevalence was constant in 2006-2008 and decreased by about 1% in 2009 (P<0.001). The prevalence of pressure ulcers identified as sDTI increased to 9% of all observed ulcers in 2009?a 3-fold increase?while the proportion of stage I and II ulcers has decreased and stage III and IV ulcers remained constant. This increase may be due in part to education of staging definitions.

The National Pressure Ulcer Advisory Panel (NPUAP) hosted a conference in 2010 to establish consensus on the avoidability of pressure ulcers. An overall 80% agreement was reached among representatives, with unanimous consensus reached for the following: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive.

This study evaluated the effects of a program converting to Hill-Rom® bed systems on the incidence of adverse events. Overall, the incidence of adverse events was reduced by the following percentages: pressure ulcers (19%), VAP (91.9%), and falls (27.7%).

This video highlights the clinical and economic need for reducing the incidence of pressure ulcers and the role of heat, moisture, and shear contributed by therapy surfaces on the development, exacerbation, and healing of pressure ulcers

In this case series, 5 patients with 10 sDTI were placed on the Clinitron® Rite Hite® AFT therapy surface within 12 hours of having the sDTI diagnosed and were also treated with standard wound care. Even with optimal treatment, sDTI wounds may rapidly progress to Stage III-IV pressure ulcers. Of the sDTIs identified: 4 healed prior to discharge, 4 evolved into stage II ulcers, and 2 remained classified as sDTI at discharge.

This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

This study assesses the impact of a new low-air-loss, continuous lateral rotation therapy bed in 21 obese, bariatric acute care patients. During this pilot study, pressure ulcers decreased in size from an average 5.2 cm2 to 2.6 cm2, and no new pressure ulcers developed.

Patients with suspected deep tissue injuries (sDTI) were placed on the Clinitron Rite-Hite bed, treated with standard care, and assessed until resolution of their sDTI. Out of 5 patients and 10 ulcers, 4 healed before discharge, 2 remained at discharge, and 4 became Stage II ulcers. Patients placed on air-fluidized therapy had significantly less skin breakdown than expected.

This observational study of 30 critical care patients evaluated the impact of a pressure redistribution surface with electronic sensors on existing pressure ulcers. During the study, existing pressure ulcers decreased in volume by an average of 41% and in area by an average of 9%.

Data were collected on pressure ulcer incidence in 67 acute care facilities using the SKIN bundle. Pressure ulcer incidence decreased from >2% to <1% over a 14-month period, and no new stage III/IV facility-acquired pressure ulcers developed from August 2004 through February 2006.

This article describes how AFT is technologically different from Group 1 (Static devices / mattresses) and Group 2 (dynamic powered and nonpowered mattress replacements and overlays). Using the healing rates described by Ochs, (2004) Cuddigan and Ayello model treatment costs for severe ulcers. They find a net savings of $39, 642 to heal a 49-cm2 stage III/IV ulcer when using AFT compared to Group 2 surfaces.

This article describes a patient with a Stage IV pressure ulcer who was started on Clinitron therapy. A wound healing rate of 67% was achieved within a month of therapy and 99% after 104 days of Clinitron air-fluidized therapy. An experienced home healthcare clinician expected that a wound of this nature would take 6 months to heal.

This review describes the benefits and drawbacks of air-fluidized therapy compared to other support types in terms of factors known to impact skin breakdown: interface pressure, shear, friction, heat, and moisture. The clinical benefits of air-fluidized therapy include faster pressure ulcer healing, decreased rate of hospitalization and ER visits for long-term care pressure ulcer patients, and decreased mortality and increased comfort for patients with burns and inhalation injury

Air-fluidized therapy beds were provided for patients who required vasopressors and mechanical ventilation for at least 24 hours postoperatively. While on therapy beds, only 1 of 27 patients developed a stage I ulcer versus 40 ulcers developed in 25 patients prior to therapy bed implementation despite already being a high-risk population for the development of pressure ulcers due to severity of illness.

This study evaluated current practice trends in surface utilization for patients at high risk for developing pressure ulcers. Surface types used for high-risk patients were powered static air (28%), foam (21.7%), low air loss (16%), self-adjusting technology (8%), alternating pressure (5.2%), nonpowered static air (2.0%), and air-fluidized therapy (1.8%), demonstrating that high-risk patients were most often placed on surfaces that are inferior to specialty surfaces with regard to pressure ulcer development and breakdown.

This article reviews an ergonomically-based study of the physica lloads placed on the lumbar spine of caregivers during the operation of floor-based and ceiling-based patient lifts. Ten subjects were studied in a biodynamic laboratory. Using biometric testing, the researchers found that the forces associated with operating a floor or ceiling mechanical lift were significantly reduced when compared to manually lifting of a patient. Further, the authors found that ceiling lifts were preferable to floor lifts due to the amount of anterior/posterior shear forces

This special supplement to American Nurse Today contains a collection of articles authored by clinicians and executives to enhance the efforts of Fall Prevention programs to create fall-safe environments

This article is a review of aresident lifting program that was implemented in an extended care facility. The facility installed ceiling lift systems for 125 beds and three tubs. A review of injury reports was conducted for a three year period prior to implementation and for three years post-implementation. Injuries were categorized according to the task being performed at the time of injury. Overall patient handling injuries decreased from 65 to 47, however lifting and transferring injury claims decreased from 30 to 10. Estimations were calculated for the cost savings from injury avoidance amounted to $1,257,605.

This article describes the revised NIOSH (National Institute for Occupational Safety and Health) tool for calculating the recommended weight limit for manual lifting. In general, NIOSH recommends a 35-pound limit for patient handling tasks. Assisting devices should be used when weights to be lifted exceed 35 pounds.

This study evaluated the economic impact of a multidisciplinary falls prevention program on patients aged ≥70. Falls were self-reported and collected in 12 monthly diaries. Mean falls rates were 2.07 per person/year in the intervention arm and 2.24 per person/year in the control arm. There was a mean incremental cost reduction of 3,320 GBP per fall averted.

This article reviews a study that was completed at 23 high-risk VHA units that implemented a safe patient handling program. The units served as their own historical controls by comparing post-implementation data to the previous year's same nine-month period. 537 staff members were involved in the study from 19 nursing homes and 4 spinal cord injury units. A cost-benefit analysis was conducted to evaluate the effectiveness of the program. After taking account of the capital costs associated with the purchase of the equipment, the program resulted in an estimated cost savings of $155,719 for the nine-month period. Additionally, a statistically significant reduction in carevier injuries occurred, resulting in a decrease in lost work days and worker's compensation costs.

Commonly referred to as PHAMA, this white paper serves as a guideline for facilities on patient handling and movement. This guide also serves as a 'how-to' for facilities that are engaging in new construction or redesign. The guideline is a requirement for participants to conduct a patient handling and movement assessment in order to best design a physical space that will be conducive to patient and caregiver safety

This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare reciepients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting

This series of articles describes safe lifting practices for nurses, including assessment of a patient's handling needs, and incorporation of slings and lifts to safely move patients without causing injury to nurses.

This practice alert make recommendations on delirium assessment and management. These recommendations include assessing all ICU patients for delirium using validated tools and implementing strategies to decrease delirium risk fators including early exercise.

These practice guidelines make recommendations on the management of pain, agitation, and delirium in adult patients in the ICU. The article discusses the association of delirium with increased mortality in adult ICU patients, prolonged ICU and hospital LOS, and the development of post-ICU cognitive impairment. Recommendations include performing early mobilization of adult ICU patients whenever feasible to reduce the incidence and duration of delirium

This interprofessional national standard from the American Nurses Association reviews the need for safe patient handling and mobility for healthcare reciepients and care providers in terms of safety for all involved. It proposes eight standards that are relevant to those involved regardless of the care setting

This article describes best practices in fall prevention. Topics discussed include fall risk assessment, education to prevent falls, interdisciplinary collaboration in fall prevention, and strategies to identify patients at high risk for falls in the acute-care setting

This resource guide explains how to develop, implement and maintain a safe patient handling program in an acute care environment to reduce the risk of patient falls, skin breakdown, and injury to healthcare worker

This toolkit is designed to be a self-guided, one-stop resource for your program needs offering a step-by-step approach with tools, industry research and information and customizable templates to support your program developmentand implementation.

This articles provides a framework for financial justification of implementing an early mobility protocol in ICU's. It uses previously published cost data with measured reductions in ICU and Hospital Length of Stay to provide the financial justification. John's Hopkins saw a net cost savings of $817,836 from their investment in an early mobility protocol and technology

The objective of this workshop is to define and create a SPH program customized to your organization’s goals. Led by one of Hill-Rom’s Directors of SPH Programs and Services, your team will be guided through:• Create a foundation on the value of a SPH Program Plan and review theory-driven approachesto create and sustain change in your practice• Develop customized SPH policy and procedures for implementation• Develop operational processes to support your program• Create education schedules based on materials in the Safe Transfers and Movement™ Program

This toolkit provides practical and effective strategies and tools for mitigating and preventing pressure ulcers. The toolkit includes examples of organizations who have demonstrated success in preventing and treating pressure ulcers and it’s purpose is to educate staff at other organizations to apply similar strategies and initiatives

In this 30min video, Dr. William Schweickert of University of Pennsylvania, details the importance of early mobility in critically ill patients and how to bridge the implementation gap. He also summarizes findings from his recent work on the recent publication: A Survey Of International Practices And Infrastructure To Support Early Mobilization which showed that <30% of global ICU’s have a written early mobility protocol and known barriers can be overcome. He concludes with a proposed framework for early mobilization and practical advice to get started.

This toolkit provides practical and effective strategies and tools for mitigating and preventing pressure ulcers. The toolkit includes examples of organizations who have demonstrated success in preventing and treating pressure ulcers and it’s purpose is to educate staff at other organizations to apply similar strategies and initiatives.

This article describes how AFT is technologically different from Group 1 (Static devices / mattresses) and Group 2 (dynamic powered and nonpowered mattress replacements and overlays). Using the healing rates described by Ochs, (2004) Cuddigan and Ayello model treatment costs for severe ulcers. They find a net savings of $39, 642 to heal a 49-cm2 stage III/IV ulcer when using AFT compared to Group 2 surfaces.

This policy establishes the standard for collecting, using and protecting Personal Information. It covers any Personal Information that is collected, stored, processed, or transferred in electronic form on this website.

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This policy establishes the standard for collecting, using and protecting Personal Information. It covers any Personal Information that is collected, stored, processed, or transferred in electronic form on this website.

Purpose

Please read this policy carefully as it sets out the conditions under which your Personal Information will be used by HRC. If you do not agree to this use, please do not accept these conditions and your Personal Information will not be stored or used by HRC.

HRC collects stores and processes information, including Personal Information in the ordinary course of business, including through this website. HRC will use this information for analytical, communication, marketing and sales purposes. This may include using these data for contacting you in person, by mail, e-mail and phone unsolicited. By accepting this policy you agree hereto. HRC’s use of Personal Information shall be consistent with consent obtained herein. HRC will obtain a new consent if Personal Information will be used for a purpose other than designated herein.

* If you do not agree to this use, please do not accept these conditions and your Personal Information will not be stored or used by HRC.

Personal Information has the following meaning.

Personal Information means information which relates to an individual who can be identified from that information, whether or not in conjunction with any other information. Common examples of personal data which may be used by HRC in its day to day business include names, addresses, e-mail addresses, affiliation with commercial organizations (customers), user history & profiles of our website, telephone numbers and other contact details.

HRC does not collect any Sensitive Personal Information, which has the following meaning:

Sensitive Personal Information consists of data of an individual relating to the racial or ethnic origin, political opinions, religious beliefs, sexual orientation, physical or mental health or condition and the commission or alleged commission or any offence.

Please do not submit this type of information.

Data transfer

In addition to the intended use as described above, you agree that your Personal Information may be transferred by HRC to the USA, to any country within the European Economic Area and to any country outside the USA and the European Economic Area if that that country ensures an adequate level of protection of Personal Information. HRC has signed an agreement with HRC Inc. containing the Standard Contractual Clauses (“SCC”) as defined in the EU Data Protection Directive (95/46/EC). HRC business units in the United States must always follow the data privacy principles as contained in the

SCC, which may be more detailed than corresponding provisions of this Policy. It is possible for Personal Information to be transferred to additional countries once it has been determined that they provide a suitable level of protection.

HRC may share an individual’s Personal Information with Third Parties as required for normal business operations, including providing services and products to patients, health care professionals and employees.

Onward Transfer

When disclosing Personal Information to third parties, HRC shall only do so for the purposes identified herein. HRC shall assure that HRC’s actions align with the consent provided, in addition to any legal and/or regulatory requirements. HRC will assure and requires from these third parties, through contractual clauses and/or written agreements to adhere to a baseline of privacy and information security controls consistent with the principles laid down herein.

* If you do not agree to this transfer, please do not accept these conditions and your Personal Information will not be stored or used by HRC.

Under certain limited or exceptional circumstances, HRC may, as permitted or required by applicable laws and obligations, make Personal Information available outside the scope of this policy. Examples of such circumstances include investigation of specific allegations of wrongdoing or criminal activity, protecting our employees, the public or HRC from harm or wrongdoing, cooperating with law enforcement agencies, auditing financial results or compliance activities, responding to legal requirements or process, meeting legal or insurance requirements or defending legal claims or interests, satisfying employment laws or agreements or other legal obligations, collecting debts, protecting HRC’s information assets, in emergency situations, when vital interests are at stake.

Monitoring and Enforcement

HRC is committed to monitoring and enforcing ongoing compliance with this policy and with applicable privacy laws, regulations and obligations.

Any and all potential, apparent or actual violations of this policy may be reported to HRC. HRC commits to investigate and address the issues in a diligent manner and keep the complaining party informed about the progress or outcome of an investigation.

Deletion of Personal Information

HRC reserves the right to delete from its systems Personal Information at any time at its’ discretion.

Precedence

In the event of a conflict between this policy and any applicable law or regulation, the latter shall prevail.

Opt out

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This toolkit provides practical and effective strategies and tools for mitigating and preventing pressure ulcers. The toolkit includes examples of organizations who have demonstrated success in preventing and treating pressure ulcers and it’s purpose is to educate staff at other organizations to apply similar strategies and initiatives

During the 2013 WOCN conference held in Seattle, WA, Dr. Karen Zulkowski presented a 15 minute presentation at Hill-Rom's booth featuring the latest information on suspected Deep Tissue Injury(sDTI). This brief presentation features an overview of the February 2013 NPUAP biennial conference dedicated to sDTI state of the science, highlights sDTI IPUP trend data, and features a published sDTI case study where patients experienced less tissue breakdown than expected on the Clinitron Air Fluidized Therapy surface.

REPLAY of webinar presented by Elizabeth Ayello PhD, RN, ACNS-BC, CWON, MAPWCA,FAAN designed to provide you with up-to-date information on best practices for prevention and treatment of pressure ulcers. Includes latest statistics on national problem of pressure ulceres and how to address this through use of skin and risk assessments as well as the science behind surface selection

FILE DOWNLOAD of webinar presented by Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN designed to provide you with up-to-date information on best practices for prevention and treatment of pressure ulcers. Includes latest statistics on national problem of pressure ulcers and how to address this through use of skin and risk assessments as well as the science behind surface selection

This study evaluated current practice trends in surface utilization for patients at high risk for developing pressure ulcers. Surface types used for high-risk patients were powered static air (28%), foam (21.7%), low air loss (16%), self-adjusting technology (8%), alternating pressure (5.2%), nonpowered static air (2.0%), and air-fluidized therapy (1.8%), demonstrating that high-risk patients were most often placed on surfaces that are inferior to specialty surfaces with regard to pressure ulcer development and breakdown.

The 2011 IPUP survey included 104,266 patients, and demonstrated a significant decrease in Overall Prevalence (OP) beginning in 2007 and Facility Acquired Prevalence (FAP) beginning in 2008. However, at present one in ten patients has an ulcer and nearly one in 20 develop one. Acute Care and Rehab had decreased OP and FAP, while LTC remained steady and LTAC OP and FAP increased in 2011. Prevalence by Age increases dramatically after age 60. By stage, severe ulcers as a proportion of all ulcers, have remained constant, and sDTI’s are now 11% of all identified ulcers

This report analyzed data from the US 2006 and 2007 IPUP surveys and revealed an overall decrease in pressure ulcer prevalence from 2004-2005 to 2006-2007 and a higher pressure ulcer prevalence in patients with low BMI and with both low and high weights; 10% of patients were extremely obese.

This study of data from the 2009 IPUP survey focused on pressure ulcer prevalence by BMI and weight distribution revealed the following: the percentage of extremely obese patients increased from 18.3% to 20.6% in 2008-2009, 36% of survey patients have a BMI >30, and pressure ulcer prevalence is higher in patients weighing >300 lbs

This observational study evaluated the prevalence of pressure ulcers in acute care facilities. In 2008 and 2009, overall prevalence was 13.5% and 12.3%, respectively. Facility-acquired prevalence was 6% and 5%, respectively. Overall prevalence was highest in long-term acute care, while facility-acquired prevalence was highest in ICUs. Overall and facility-acquired prevalence were lower in 2008-2009 compared to 2006-2007. However, in 2009 approximately 10% of all ulcers were device related.

This article reports data from the international Pressure Ulcer Prevalence survey 2006-2009 in patients with suspected deep tissue injury (sDTI). Overall and facility-acquired pressure ulcer prevalence was constant in 2006-2008 and decreased by about 1% in 2009 (P<0.001). The prevalence of pressure ulcers identified as sDTI increased to 9% of all observed ulcers in 2009?a 3-fold increase?while the proportion of stage I and II ulcers has decreased and stage III and IV ulcers remained constant. This increase may be due in part to education of staging definitions.

This case study of 3 patients in the home care and extended care settings monitor the healing of existing pressure ulcers and the development of new pressure ulcers in patients on the P400 therapy surface. Positive results for healing were seen in all 3 patients

This study evaluated the effects of a program converting to Hill-Rom® bed systems on the incidence of adverse events. Overall, the incidence of adverse events was reduced by the following percentages: pressure ulcers (19%), VAP (91.9%), and falls (27.7%).

In this case series, 5 patients with 10 sDTI were placed on the Clinitron® Rite Hite® AFT therapy surface within 12 hours of having the sDTI diagnosed and were also treated with standard wound care. Even with optimal treatment, sDTI wounds may rapidly progress to Stage III-IV pressure ulcers. Of the sDTIs identified: 4 healed prior to discharge, 4 evolved into stage II ulcers, and 2 remained classified as sDTI at discharge.

This observational study of 30 critical care patients evaluated the impact of a pressure redistribution surface with electronic sensors on existing pressure ulcers. During the study, existing pressure ulcers decreased in volume by an average of 41% and in area by an average of 9%.

This article describes a patient with a Stage IV pressure ulcer who was started on Clinitron therapy. A wound healing rate of 67% was achieved within a month of therapy and 99% after 104 days of Clinitron air-fluidized therapy. An experienced home healthcare clinician expected that a wound of this nature would take 6 months to heal.

Air-fluidized therapy beds were provided for patients who required vasopressors and mechanical ventilation for at least 24 hours postoperatively. While on therapy beds, only 1 of 27 patients developed a stage I ulcer versus 40 ulcers developed in 25 patients prior to therapy bed implementation despite already being a high-risk population for the development of pressure ulcers due to severity of illness.

This study assesses the impact of a new low-air-loss, continuous lateral rotation therapy bed in 21 obese, bariatric acute care patients. During this pilot study, pressure ulcers decreased in size from an average 5.2 cm2 to 2.6 cm2, and no new pressure ulcers developed.

The National Pressure Ulcer Advisory Panel (NPUAP) hosted a conference in 2010 to establish consensus on the avoidability of pressure ulcers. An overall 80% agreement was reached among representatives, with unanimous consensus reached for the following: most PrUs are avoidable; not all PrUs are avoidable; there are situations that render PrU development unavoidable, including hemodynamic instability that is worsened with physical movement and inability to maintain nutrition and hydration status and the presence of an advanced directive prohibiting artificial nutrition/hydration; pressure redistribution surfaces cannot replace turning and repositioning; and if enough pressure was removed from the external body the skin cannot always survive.

This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

This study assesses the impact of a new low-air-loss, continuous lateral rotation therapy bed in 21 obese, bariatric acute care patients. During this pilot study, pressure ulcers decreased in size from an average 5.2 cm2 to 2.6 cm2, and no new pressure ulcers developed.

This article describes how AFT is technologically different from Group 1 (Static devices / mattresses) and Group 2 (dynamic powered and nonpowered mattress replacements and overlays). Using the healing rates described by Ochs, (2004) Cuddigan and Ayello model treatment costs for severe ulcers. They find a net savings of $39, 642 to heal a 49-cm2 stage III/IV ulcer when using AFT compared to Group 2 surfaces.

Air-fluidized therapy beds were provided for patients who required vasopressors and mechanical ventilation for at least 24 hours postoperatively. While on therapy beds, only 1 of 27 patients developed a stage I ulcer versus 40 ulcers developed in 25 patients prior to therapy bed implementation despite already being a high-risk population for the development of pressure ulcers due to severity of illness.

This study evaluated current practice trends in surface utilization for patients at high risk for developing pressure ulcers. Surface types used for high-risk patients were powered static air (28%), foam (21.7%), low air loss (16%), self-adjusting technology (8%), alternating pressure (5.2%), nonpowered static air (2.0%), and air-fluidized therapy (1.8%), demonstrating that high-risk patients were most often placed on surfaces that are inferior to specialty surfaces with regard to pressure ulcer development and breakdown.

This study evaluated the change in existing pressure ulcers and incidence of new pressure ulcers in surgical ICU patients using a new low-air-loss, weight-based, microclimate management (LAL-MCM) system compared to the standard SICU bed with an integrated, powered air pressure redistribution (IP-AR) surface. Incidence of supine pressure ulcers was 0% in the LAL-MCM group and 18% in the IP-AR group (P=0.046), despite more comorbidities in the patients in the LAL-MCM group.

This independent cost analysis investigated the impact of a high-frequency chest wall oscillation system on total health care expenditures in patients with cystic fibrosis. The study found that health care costs following the use of the system were reduced by 49%.

This report analyzed data from the US 2006 and 2007 IPUP surveys and revealed an overall decrease in pressure ulcer prevalence from 2004-2005 to 2006-2007 and a higher pressure ulcer prevalence in patients with low BMI and with both low and high weights; 10% of patients were extremely obese.